Provider Demographics
NPI:1871298174
Name:SHEPHERD, SAMANTHA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:BACHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 CREEKSIDE DR STE 2500
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3485
Mailing Address - Country:US
Mailing Address - Phone:916-542-1458
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DR STE 2500
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3485
Practice Address - Country:US
Practice Address - Phone:916-542-1458
Practice Address - Fax:916-936-0640
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily